January 5, 2026
By Donna Sutton, Diabetes Clinical Lead, Spirit Health
In a recent survey by the EMPOWER team, 58% of NHS healthcare professionals told us that patient reluctance is a barrier to structured diabetes education uptake[1]. That statistic will resonate with many diabetes teams. Reluctance shows up every day – as missed appointments, declined referrals, or patients who simply don’t respond.
It’s a real problem, and one that sits alongside already stretched capacity, increasing demand, and limited time for follow-up. So when uptake is low, it’s understandable that reluctance can feel like a fixed barrier – something we have to work around rather than something we can influence.
But our experience suggests something slightly different: patient reluctance is rarely static. It is shaped by how people experience diagnosis, how education is introduced, and how clearly we prepare them for what comes next.
Reluctance is often a signal, not a refusal
When patients hesitate or decline diabetes education, it’s easy to interpret this as a lack of motivation or engagement. In reality, reluctance is more often rooted in uncertainty.
Patients frequently describe:
- Fear of being judged or “told off”
- Feeling overwhelmed at the point of diagnosis
- Uncertainty about what education actually involves
- Concerns about group settings or not feeling they’ll relate to others attending
For some, attending education feels like accepting an identity they are not yet ready to process. For others, previous negative experiences of group education influence their expectations before they ever receive an invitation.
Seen in this light, reluctance isn’t a dead end – it’s a signal that something in the pathway hasn’t yet helped the patient feel ready.
Why common engagement approaches fall short
Many current responses to low uptake are well-intentioned but limited in impact. One-off invitations, risk-heavy messaging, or simply repeating the same referral process rarely change how a patient feels about attending.
We often assume that if patients fully understood the risks of diabetes, they would be more likely to engage. But understanding risk does not always translate into readiness, particularly when people are still processing a new diagnosis or feeling emotionally overloaded.
Similarly, framing structured education as an optional add-on rather than a core part of diabetes care can unintentionally reinforce hesitation. When education feels like an extra choice rather than a standard step, it becomes easier to delay or decline.
Reducing reluctance without adding workload
The encouraging news is that reducing reluctance does not require significant additional clinical capacity. Small, well-designed changes to how education is introduced can make a meaningful difference.
Approaches that consistently help include:
- Pre-education touchpoints, such as short leaflets, videos, or FAQs shared before the first invitation
- Clear expectation-setting, explaining what the session involves, who delivers it, and what patients can expect on the day
- Real patient stories and outcomes, helping people see themselves reflected in others’ experiences
- Positioning education as part of the standard pathway, not an optional extra
These steps help patients feel informed and prepared before they are asked to attend – reducing anxiety and increasing confidence.
Timing and consistency matter
When education is offered too quickly, patients may feel overwhelmed. When it’s offered too late, momentum is lost. Striking the right balance and reinforcing invitations over time is key.
Consistency also matters. Variation in how education is discussed or promoted across services can lead to mixed messages for patients and reduced confidence in its value. Where education is embedded clearly and consistently within the diabetes pathway, uptake and engagement tend to improve.
A shared opportunity
Patient reluctance is a genuine barrier, but it’s not immovable. How services respond to it can either reinforce hesitation or reduce it.
Rather than asking how we can persuade patients to attend, a more productive question may be: how well are we preparing them to say yes?
By designing pathways that acknowledge uncertainty, normalise hesitation, and set clear expectations, we can improve uptake in a way that supports both patients and the professionals caring for them.
This matters. Diabetes already accounts for around £10 billion of NHS spend each year, approximately 10% of the total budget[2]. Structured diabetes education is associated with improvements in HbA1c[3] and greater patient understanding of their condition, helping people make informed decisions earlier and manage their diabetes more confidently. Over time, this can support better outcomes and reduce avoidable pressure on services.
[1] Spirit Health, 2025. Data on file.
[2] NHS England, 2022. NHS Prevention Programme cuts chances of Type 2 diabetes for thousands
[3] Sutton D et al. Structured Diabetes Education: virtual access was as effective as face-to-face access to a structured diabetes education programme (EMPOWER T2n) for people with type 2
CLI5502DEC25
